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P&S with restrictions but no disability rating. What?
#71
Sure thing.
glad you are willing to tackle it by yourself.
Keep your treatment current. Med bills keep them motivated to settle.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#72
Thanks, but they're not reimbursing them so I'm just hanging on to them. Should I continue to submit anyway?
 
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#73
And honestly I don't feel like I'm tackling anything. Feel more like a sitting duck. What should a lawyer charge to negotiate settlement? Still the normal 15% even though it's the tail end of the case? I feel like I need one to help me navigate reimbursement for medical expenses too.
 
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#74
You're fine.
Things can't get too out of hand; the court has to approve any settlement.
They won't let them take a big an advantage-especially if you are unrepresented.
Comp is very low: 15% atty fee.
The doctors should be billing them direct.
Send them a written request for re-imbursement with documentation and notify them that you are re-questing automatic penalties and will be also requesting additional penalties from the board. Keep copies.
This builds negotiating leverage. Do this with each bill. Penalties are cumulative and there are additional fines for a documented pattern of behavior. More leverage.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#75
You're fine.
Things can't get too out of hand; the court has to approve any settlement.
They won't let them take an advantage-especially if you are unrepresented.
Comp is very low: 15% atty fee.
The doctors should be billing them direct.
Send them a written request for re-imbursement with documentation and notify them that you are requesting automatic penalties and if necessary will ask for additional penalties from the board. Keep copies.
This builds negotiating leverage.
Do this with each bill.
Penalties are cumulative and there are additional fines for a documented pattern of behavior. More pressure & More leverage.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
Reply
#76
Here is the last I heard about medical reimbursement. My doctors here don't have a clue about any of this so I don't know what to do. This is from the defense attorney:
Please understand any further requests for reimbursement for self-procured
medical expenses must include a report from the treating physician satisfying the
requirements of California Regulation 9785. We would also need an Request
For Authorization required for Utilization Review purposes, along with billings
pursuant to the California's Fee Schedule for the appropriate bill review.
 
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#77
Yup; they are not going to pay in a vacuum.
Even if they are not MPN docs, they still need to provide documentation of the treatment. Most docs know this even if they don't have the exact form. Hopefully they will be willing to send in some paperwork even if it's just chart notes.
All the med reporting forms are on line at the DWC website.
It's very basic med info.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#78
Yeah, my doc will send it but utilization review has already denied all recommended treatment.
Uphill battle especially now that they have an attorney. This system is so difficult
 
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#79
Yup. When med was open ended and docs had a blank check it was abused.
Now Everything has to be documented.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#80
(05-24-2017, 01:25 AM)1 Hurt nurse Wrote: Yeah, my doc will send it but utilization review has already denied all recommended treatment.
Uphill battle especially now that they have an attorney. This system is so difficult

Hurt nurse make sure your doctor is sending in his requests on the correct form called an RFA. The link I provided you previously has those forms if you want to print to give to your doctor.

California workers compensation follows MTUS guidelines. ACOEM and ODG. If you want something approved you really need to submit with those guidelines or if your condition or request goes outside of those guidelines, you can submit others by searching internet for example. You as a patient can also submit a UR appeal to the UR company directly addressing the reasons for the denial. There is usually a 5-10 day deadline for this. If you need help with this I can help. The MTUS guidelines are also on the states webpage. What I have done is research guidelines needed and gently hand them to my doctor and say if this can help...and it usually does.

You can shop around for an attorney to take your case. I do not think they would take 15% but that would be up to a judge.

Being out of state it is important to close out your medical if all of your medical treatment is being denied, in my opinion. You should be submitting receipts for reimbursement. There is mileage forms on the states website and I use them and black out the mileage info. I number each receipt and tape them to a piece if typing paper. You should ask your doctors office for a copy of his report for each visit and attach it as well.

Again, if he is not sending in the RFA form they can legally ignore his treatment requests. I can show you how I do internal UR appeals or gather appropriate rational to make a strong request using treatment guidelines. Most (not all) of my appeals go in my favor and some doctors are now using my system. If you need my help let me know.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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